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The aim of the present in vitro comparative study is to validate a novel composite polymer, named "ONLY", developed to overcome the mechanical drawbacks of conventional, metal-reinforced poly(methyl methacrylate) (PMMA) interim restoration. Ten interim restorations were designed and fabricated (five in the composite "ONLY" group, and five in the metal-reinforced PMMA group). All the samples were screwed into the prototype models, simulating a complete edentulous mandible rehabilitated with six straight implants. Outcome measures were break point (load, N) and displacement (mm) through a static compression test, and material behavior through a dynamic cyclic test method (fatigue test). A total of 20 samples were tested (10 for static and 10 for dynamic). In each group, five samples (test and control) were used. All the specimens completed the mechanical tests, as planned. There was no statistically significant difference between groups for any test. In the test group, the break point was 1953.19 ± 543.73 N, while it was 2031.10 ± 716.68 N in the control group (p = 0.775). The displacement was 1.89 ± 0.34 mm in the test group and 1.98 ± 0.75 mm in the control group (p = 0.763). Using the dynamic cyclic test method, in the control group the mean load was 2504.60 ± 972.15 N, while in the test group the mean load was 3382.00 ± 578.50 N. The difference between groups was 877.40 ± 579.30 N (p value = 0.121). Within the limitations of this in vitro study, the novel composite polymer can be used to immediately load dental implants. Further clinical research is needed to confirm these preliminary results. [ABSTRACT FROM AUTHOR]

Background: Digital technologies enable the accurate replication of occlusion, which is pivotal for stability in maximum intercuspation and dynamic occlusion. CAD softwares generates standardized occlusal morphologies requiring significant adjustments. The consideration of individual mandibular movements during restoration leads to better functional integration. This pilot study evaluates the efficacy of a novel, fully digital protocol for occlusal analysis recording in prosthodontics. Methods: Patients needing single or multiple metal-free restorations were included. Teeth underwent horizontal finish line preparation, while restorations on implants were either directly screwed or used multi-unit abutments. A digital impression (Trios 3 Intraoral Scanner) captured the mouth's elements. Dynamic occlusion was recorded via Patient Specific Motion (PSM). After the placement and functionalization of temporary restorations, subsequent scans included various elements, and CAD software (Dental system) was used for the restoration design. Restorations were milled in monolithic zirconia, pressed from CAD/CAM-milled wax, and sintered. Results: An evaluation of 52 restorations in 37 patients indicated high accuracy in restorations manufactured via the fully digital workflow. Monolithic zirconia was predominantly used. Subtractive (17.3%) and additive (7.7%) occlusal adjustments were mainly chairside. Conclusion: This study underscores the efficacy of meticulous verification measures and a centric contact system in reducing the need for clinical occlusal refinements in prosthetic restorations. [ABSTRACT FROM AUTHOR]

This report aims to clinically evaluate the feasibility of a novel biological-oriented digital impression method for teeth prepared with a vertical preparation technique. Something that makes this case unique is that the definitive impression is taken without cord displacement, reducing the invasiveness for the patient. In addition, dental technicians can reproduce the exact emergence profile of the temporary restoration used to reshape the soft tissue contours and define the accurate finish line at the established prosthetic junction, potentially avoiding the aesthetic and biological issues of the double-cord technique. The finish line and emergence profile are transferred using the temporary restoration through a simple CAD procedure performed using the same software used to take the impression. This makes the proposed biological-oriented digital impression technique (BODIT) easy to perform, avoiding adjunctive time and costs for clinicians and patients. Conclusions: Finally, patients' satisfaction could be significantly improved. [ABSTRACT FROM AUTHOR]

This study evaluated the prophylactic effect of localized biomimetic minocycline and systemic amoxicillin on immediate implant placement at infected extraction sites. Twelve mongrels with six implants each were randomly assigned to five groups: uninfected negative control (Group N); infected with oral complex bacteria (Group P); infected and treated with amoxicillin one hour before implant placement (Group A); infected and treated with minocycline during implant placement (Group B); and infected and treated with amoxicillin one hour before implant placement and with minocycline during implant placement (Group C). Radiographic bone level, gingival index (GI), probing depth (PD), papillary bleeding index (PBI), and removal torque (RT) were recorded. There was no significant difference between Groups A, B, and C for bone loss. Group A showed the highest RT, the lowest PBI, and significantly lower GI and PD values than Group P. Group B exhibited significantly higher RT value than Group N and significantly smaller PD value than Group P at 6 w postoperatively. Localized minocycline could improve implant success by reducing bone loss and increasing RT and systemic amoxicillin could maintain the stability of the peri-implant soft tissue. However, combined use of these two antibiotics did not augment the prophylactic effect. [ABSTRACT FROM AUTHOR]

Restoring teeth with dental implants has become the gold standard in recent years, especially in the esthetic zone. However, limited amount of available bone as well as limited interdental space in the anterior zone may create problems for implant treatment. Narrow diameter implants (NDI) may be a treatment option to resolve the above-mentioned limitations and providing minimally invasive implant therapy without additional regenerative procedures. In this retrospective study, a comparison of clinical and radiographic outcomes between one-piece and two-piece titanium-made NDIs was done with the follow-up of two years after loading. Twenty-three NDI cases were analyzed, 11 in the one-piece implant group (group one) and 12 in the two-piece implant group (group two). The outcomes were implant and prosthetic failures, any complications occurred, peri-implant bone level changes, and as well as the Pink Esthetic score. No implant or prosthetic failures, as well as, no complications were reported at the two-year follow-up examination. At the same time the marginal bone loss was 0.23 ± 0.11 in the group one and 0.18 ± 0.12 in the group two. Difference was not statistically significant (p = 0.3339). The Pink Esthetic Score, recorded two years after definitive loading, was 12.6 ± 0.97 in the group one and 12.2 ± 0.92 in the group two, with no statistically significant difference between groups (p = 0.3554). With the limitations of the present study, including the small sample size and short follow-up, it is possible to conclude that either one and two-piece NDI can be successfully used to restore lateral incisors with comparable results within the two years of follow-up. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to investigate quantitative histological examination of bone reconstructed with non-resorbable high-density polytetrafluoroethylene membrane (d-PTFE), left intentionally exposed in post extraction sockets grafted with anorganic bone material, and removed after four weeks, versus extraction and guided bone regeneration (GBR), performed two months later. Materials and Methods: This study was designed as a multicenter randomized controlled trial of parallel-group design. Patients were selected and consecutively treated in three centers in Italy. Patients randomly received intentionally exposed non-resorbable d-PTFE membrane (group A), or guided bone regeneration (group B), to treat post-extractive alveolar bone defects with implant-supported restorations. Outcomes were: the implant failure, any mechanical and biological complications, patient satisfaction, and qualitative and histomorphometric evaluation of the collected bone samples. Results: Eighteen patients were consecutively enrolled in the trial. Of these, six out of 18 patients were male. All the included patients were treated according to the allocated interventions, and no drop out occurred. No implant failure and no complications were experienced, and all the patients were fully satisfied with the function and aesthetic of their implant-supported restoration, without difference between groups. Morphological analysis revealed no sign of tissue reaction, such as fibrosis or necrosis. Regenerated bone was well mineralized in both groups, but it seemed more mature in group B than in group A. Three samples showed a minimal number of lymphocytes. Several blood vessels of small size occupied the medullary spaces, where the tissue resulted in more maturity, indicating the activity of the tissue in progress. The histomorphometric evaluation showed no statistically significant differences in the tissue volume fractions between the two groups of patients. Conclusions: With the limitation of the present study, buccal plate reconstruction with an intentionally exposed non-resorbable membrane is an effective and easy procedure for regenerating a resorbed buccal bone plate, reducing the need for guided bone regeneration. [ABSTRACT FROM AUTHOR]

Aim: The aim of this in vitro study is to present a debonding protocol developed to remove a screw-retained, monolithic, zirconia restoration from its titanium-base abutment, and to microscopically evaluate the abutment integrity at both the prosthetic and connection levels. Materials and Methods: A total of 30 samples were tested. Each sample consisted of a monolithic zirconia restoration bonded on a titanium link abutment. Five different shapes were designed and fabricated. Randomly, one-third of the Ti-link abutments were subjected to an anodizing process. Then, all the zirconia samples were bonded to the Ti-link abutments according to a pre-established protocol. Forty-eight hours later, the samples were debonded according to the experimental protocol. The outcomes were evaluated by a visual inspection with an optical microscope, scanning electron microscopy (SEM), and chemical composition analysis. Results: Thirty samples were collected and visually analyzed. Seven samples were randomly evaluated via scanning electron microscopy. In all the examinations, no relevant changes were reported. Chemical composition analysis also relieved no changes in the chemical structure of the titanium. Conclusions: The titanium-base abutments do not alter the structure and properties of the material, not creating phase changes or the birth of oxides such as to induce fragility. Further clinical studies with longer follow-up periods are needed to confirm these preliminary results. [ABSTRACT FROM AUTHOR]

Fully digital workflow in implant dentistry is ever increasing. Treatment of partial edentulous cases is well-documented; nevertheless, complete edentulous cases are still a challenge. To present several innovations in the treatment of complete edentulous patients using digital solutions, both for implant placement and restoration delivery, was the objective of this study. It was designed as a retrospective case series study, aimed to tune further research with larger sample size, and a longer follow-up. Patients requiring complete, implant-supported restoration were asked to participate in this study. Enrolled patients were treated with four implants, immediate loading and a definitive complete arch restoration. Patients were treated using computer-assisted, template-based surgery. Multi-piece surgical templates were used to accurately place the implants, to manage the bone if needed and to make immediate loading procedure quicker and easier. After osseointegration period, definitive, extra-oral, digital impressions were taken using newly developed scan analogs, connected in the patient mouth using temporary cylinders and stabilized by means of the low-shrinkage, flowable, resin composite. Outcomes were implant and prosthesis survival rate, complications, accuracy, and patient satisfaction. Radiographic evaluation performed with a preliminary, radiopaque aluminum try-in, was used to test the accuracy of the digital impressions. Overall, 20 implants were placed in five patients. All the implants osseointegrated without complications. One impression was taken a second time due to inaccuracy of the aluminum tray-in. Finally, all of the patients were completely satisfied with both surgical and prosthetic procedures. Within the limitations of this case series, multi-piece surgical templates showed promising results improving the clinician's confidence in the case of bone reduction, post-extractive implants and immediate loading. The prosthetic template increased the trueness of the digital impression for complete edentulous patients. Finally, even if an impression was performed again, the scan-analog used for extra-oral chair-side digital impressions seemed to be a promising tool. Continuous improvements and further study are needed to confirm these preliminary results. [ABSTRACT FROM AUTHOR]

The aim of this study is to compare two low-temperature sintered anorganic bovine bone materials (ABBMs), Bio-Oss (Geistlich, Wolhusen, Switzerland) and A-Oss (Osstem, Seoul, Korea), for GBR in dehiscence defects. A single implant was placed simultaneously with GBR in the buccal or bucco-proximal osseous defect by double-layering of inner allograft and outer ABBM, covered by a preformed ultrafine titanium mesh and an absorbable collagen membrane. Grafted volume changes were evaluated by cone-beam computed tomography, taken preoperatively (T0), immediately after implant surgery (T1), after re-entry surgery (T2), and after delivery of the final restoration (T3). The density of the regenerated bone was assessed by measuring the probing depth on the buccal mid-center of the mesh after removing the mesh at T2. Postoperative sequelae were also recorded. Grafted volume shrinkage of 46.0% (0.78 ± 0.37 cc) and 40.8% (0.79 ± 0.33 cc) in the Bio-Oss group (8 patients) and A-Oss group (8 patients), respectively, was observed at T3 (p < 0.001). There were no significant differences in grafted volume changes according to time periods or bone density between the two groups. Despite postoperative mesh exposure (3 patients), premature removal of these exposed meshes and additional grafting was not necessary, and all implants were functional over the 1-year follow-up period. Both ABBMs with titanium meshes showed no significant difference in the quantity and density of the regenerated bone after GBR for peri-implant defects. [ABSTRACT FROM AUTHOR]

The purpose of this multicenter randomized controlled trial was to compare the clinical, radiographic, and patient-centered outcomes of early loaded mandibular overdentures deliberately placed on two or three implants. The outcomes were: implant and prosthesis success and survival rates; biological and technical complications; marginal bone loss; patient satisfaction; and periodontal parameters. The results showed no differences between the groups in any of the outcomes analyzed. With the limitations of the present study, and looking at long-term follow-up, the gold standard of prosthetic rehabilitations with attachments, in agreement with the scientific community, should prefer two non-splinted implants. [ABSTRACT FROM AUTHOR]

To evaluate the implant and prosthetic of two implants with different surfaces and neck design. Enrolled patients received bone level, 12° conical connection implants (Nobel Parallel, Nobel Biocare; NOBEL group) with anodized surface (TiUnite) and roughness of 1.35 μm, or transmucosal implant system (Prama, Sweden and Martina; PRAMA group) with convergent collar, ZIrTi surface, and roughness 1.4–1.7 μm. Both implants were made of pure grade IV titanium, with similar diameter and length, chosen according to the dentistry department availability and patient's request. After early prosthesis delivery, patients were filled for at least one year. Outcome measures were: implant and prosthetic survival and success rates, physiological marginal bone remodeling, periodontal parameters and pink esthetic score (PES). Results: Fifteen patients were allocated and treated in each group. At the one-year follow-up, three patients dropped out, one in the NOBEL group and two in the PRAMA group. During the entire time of investigation, all implants survived and the prostheses were successful. No statistically significant differences were found in term of marginal bone loss, periodontal parameters, and aesthetics (p > 0.05). Conclusion: With the limitations of the present study, both implant systems showed successful clinical results. Finally, many other clinical and surgical variables may influenced marginal bone levels, implant survival, and periodontal parameters. More homogenous clinical trials with larger samples are needed to confirm these preliminary conclusions. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to evaluate the histological and histomorphometric characteristics of post-extraction sites grafted with decellularized bovine compact bone from bovine femur, mixed and unmixed with leukocyte- and platelet-rich fibrin after four months of healing. This study was designed as a randomized controlled trial of parallel groups. Patients in need of a single, implant-supported restoration to replace a hopeless tooth were recruited for tooth extraction and implant placement four months after socket preservation procedure. After tooth extraction, patients were randomly allocated to receive decellularized bovine compact bone from bovine femur, mixed and unmixed with leukocyte- and platelet-rich fibrin. After four months of healing, tapered implants were inserted with an insertion torque between 35 and 45 Ncm. Two months later, implants were loaded with screw-retained definitive crowns. Outcome measures were implant (ISR) and prosthesis (PSR) survival rates, complications, histological and histomorphometric analyses, radiographic marginal bone-level changes, and patients' satisfaction. Clinical data were collected up to one year after tooth extraction and socket preservation procedures. Thirty patients were consecutively enrolled in the trial (15 in each group). Unfortunately, due to the COVID-19 pandemic, bone samples were collected only in 19 patients. Two implants failed before definitive prosthesis delivery (ISR 93.3%). No prosthesis failed (PSR 100%). Three complications were experienced in the control group. The mean bone percentage was 40.64 ± 18.76 in the test group and 33.40 ± 22.38 in the control group. The difference was not statistically significant (p = 0.4846). The mean soft tissue percentage was 32.55 ± 19.45 in the test group and 55.23 ± 17.64 in the control group. The difference was statistically significant (p = 0.0235). The mean residual graft was 24.59 ± 18.39 in the test group and 11.37 ± 12.12 in the control group. The difference was not statistically significant (p = 0.0992). Mean marginal bone loss, as well as patient satisfaction, showed no differences between groups. With the limitations of the present study, socket preservation with L-PRF mixed with decellularized bovine compact bone demonstrated favorable results, comparing with decellularized bovine compact bone from bovine femur alone. Further studies with larger sample size and longer follow-up are needed to confirm these preliminary results. [ABSTRACT FROM AUTHOR]

The aim of this retrospective study was to clinically evaluate the five-year outcomes of implants placed following a combined approach to the sinus, consisting of sequential drills and osteotomes. Medical records of patients with implants placed in combination with crestal sinus lift using sequential drills and osteotomes, with a residual alveolar bone crest between 4 to 8 mm, and a follow-up of at least five years after final loading, were evaluated. Outcomes were implant and prosthetic survival and success rates, any complication, and marginal bone loss. Data from 96 patients (53 women and 43 men; mean age 54.7 years; range 23–79 years) were collected. A total of 105 single implants were analyzed. After five years of function, two implants were lost and two prostheses failed. No major biological or prosthetic complications occurred. At the five-year examination, the marginal bone loss was 1.24 ± 0.28 mm. Within the limitations of this retrospective study it can be concluded that implants placed following a combined approach to the sinus consisting of sequential drills and osteotomes seem to be a viable option for the treatment of posterior atrophic edentulous maxilla. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of the study were (1) to develop a novel multi-element-doped porous 58S bioactive glass coating for titanium implants and (2) to investigate the physiochemical, cell cytotoxic and antibacterial properties of this novel coating for titanium implants. Methods: This study employed the sol–gel method to develop a silver-, cobalt (II) oxide- and titanium dioxide-doped 58S bioactive glass coating. The surface topography and in vitro bioactivity of the new bioactive glass-coated implants were studied using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy. The surface nanohardness and coating degradation were evaluated using atomic force microscopy (AFM) and inductively coupled plasma atomic emission spectroscopy (ICP-AES), respectively. The cell cytotoxicity was assessed using cell viability of osteoblast-like mouse cells. The antibacterial property was examined using colony-forming units (CFUs) of the implant coating against Porphyromonas gingivalis. Results: The multi-element-doped porous 58S bioactive glass-coated titanium implant was synthesized. SEM showed that calcium phosphate was formed on the novel coating but not on the 58S bioactive glass coating. The mean surface nanohardness of the novel coating and the 58S coating were 124 ± 24 and 50 ± 17 MPa, respectively (p < 0.001). ICP-AES showed that the releases of Si, Ca and P ions of the novel coating were significantly higher than that of a 58S bioactive glass-coated implant. No significant difference in cell cytotoxicity was found between the novel coating and the 58S coating (p > 0.1). The mean CFUs of the novel coating and the conventional coating were 120 × 106 and 49 × 106 /mL. Conclusion: A novel multielement-doped porous bioactive glass coating for titanium implants was developed. The coating displays promising biocompatibility and antibacterial activity. Clinical significance: the coating can be used to improve the clinical success of dental implants for patient care if it shows success in clinical trials. [ABSTRACT FROM AUTHOR]

A dental implant is a medical device used to functionally and aesthetically rehabilitate the lack of one or more teeth, allowing the support of a prosthetic substitute through direct bone support. The prerequisites for the long-term success of osseointegrated dental implants are healthy bone and soft tissues. A customized surgical guide is then obtained which, fixed in the patient's mouth, guides the implant placement surgery, greatly simplifying the procedure, which does not require exposure of the bone tissue (flapless). [Extracted from the article]

Crest module can be defined as the portion of a two-piece implant designed to retain the prosthetic components and to allows the maintenance of the peri-implant tissues in the transition zone. Aim: To evaluate the three-year after loading clinical and radiographic data, collected from patients that received a prosthetic rehabilitation on conical connection implants with partial machined collar (PMC; CC Group) and same body-designed implants, with flat-to-flat connection and groovy neck design (FC Group). Materials and Methods: A retrospective chart review of previously collected data, including documents, radiographs, and pictures of patients who received at least one implant-supported restoration on NobelReplace CC PMC or NobelReplace Tapered Groovy implants was performed. Patients with at least three years of follow-up after final loading were considered for this study. Outcomes measures were implant and prosthesis failures, any biological or technical complications, marginal bone loss. Results: Eight-two patients (44 women, 38 men; average age 55.6) with 152 implants were selected and divided in two groups with 77 (CC group) and 75 (FC group), respectively. Three years after final loading, one implant in CC group failed (98.7% survival rate), while no implants failed in FC group (100% survival rate). One restoration failed in CC group (98.7% survival rate) with no restoration failing in the FC one (100% survival rate). Differences were not statistically significant (p = 1.0). Three years after final loading, mean marginal bone loss was 0.22 ± 0.06 mm (95% CI 0.2–0.24) in CC group and 0.62 ± 0.30 mm (95% CI 0.52–0.72) in FC group. The difference was statistically significant (0.40 ± 0.13 mm; 95% CI 0.3–0.5; p = 0.003). Conclusion: with the limitation of this retrospective comparative study, implants with conical connection and partial machined collar seem to achieve a trend of superior outcomes if compared with implants with flat connection and groovy collar design. [ABSTRACT FROM AUTHOR]

Ultraviolet (UV) photofunctionalization can reset the biological aging of titanium after the preparation and storage of dental implants by transforming hydrophobic titanium surfaces into superhydrophilic surfaces. Blood clot formation around the implant can initialize and promote the healing process at the bone–implant interface. The aim of this study is to evaluate and compare the capabilities of surface wettability and blood clotting of implants with a conventional sand-blasted and acid-etched surface (SA), a sand-blasted and acid-etched surface with vacuum-UV treatment (SA + VUV), and a sand-blasted and acid-etched surface coated with a pH-buffering agent after vacuum-UV treatment (SA + VUV + BS). Static and dynamic tests for surface wettability and blood clotting were performed in vitro for SA + VUV and SA + VUV + BS (n = 5), while hemostasis resulting from blood clotting was evaluated in vivo for SA, SA +VUV, and SA + VUV + BS (n = 4). A Kruskal–Wallis test showed statistically significant differences (p < 0.05) in all tests, with the exception of in vitro test of static blood clotting. VUV treatment is therefore effective at making an SA surface superhydrophilic as an alternative to routine UV-C radiation. The addition of a pH-buffering agent to SA + VUV also improved surface wettability and blood clotting, which are crucial for successful osseointegration. [ABSTRACT FROM AUTHOR]

Alveolar-ridge augmentation, anterior aesthetics, and digital technologies are probably the most popular topics in the dental-implant field. The aim of this report is to present a clinical case of severe atrophy of the anterior maxilla in a younger female patient, treated with a titanium membrane customized with computer-aided design/computer-aided manufacturing (CAD/CAM), simultaneous guided implant placement, and a fully digital workflow. A young female patient with a history of maxillary trauma was treated and followed-up for 1 year after implant placement. A narrow implant was inserted in a prosthetically driven position with the aid of computer-guided surgery. In the same surgical section, a customized implantable titanium mesh was applied. The scaffold was designed according to the contralateral maxillary outline in order to recreate a favorable maxillary bone volume. Finally, highly aesthetic, CAD/CAM, metal-free restorations were delivered using novel digital technologies. [ABSTRACT FROM AUTHOR]

Background: Intraoral scanners (IOSs) in implantology represent a viable approach for single teeth or partial arches. However, when used for complete edentulous arches or long-span edentulous areas, it has been demonstrated that there is a need for improvement of IOS-related techniques. Therefore, the aim of this in vitro study was to assess the trueness and precision of a complete arch digital impression on four and six implants taken with or without a customized, prosthetic-based impression template. Materials and Methods: Two experimental models were prepared, representative of a complete edentulous mandible restored with four and six implants with built-in scan abutments. Models were scanned with (test group, TG) or without (control group, CG) the prosthetic-based impression template. Eight scans were taken for each model. The time needed to take impressions, error, trueness, and precision were evaluated. A statistical analysis was performed. Results: In the case of four implants, the time needed for the impression was 128.7 ± 55.3 s in the TG and 81.0 ± 23.5 s in the CG (p = 0.0416). With six scan abutments, the time was 197.5 ± 26.8 and 110.6 ± 25.2 s in the TG and CG, respectively (p = 0.0000). In the TG, no errors were experienced, while in the CG, 13 impressions were retaken due to incorrect stitching processes. In the four-implant impression, the mean angle deviation was 0.252 ± 0.068° (95% CI 0.021–0.115°) in the CG and 0.134 ± 0.053° (95% CI 0.016–0.090°) in the TG. The difference was statistically significant (p = 0.002). In the six-implant impression, the mean angle deviation was 0.373 ± 0.117° (95% CI 0.036–0.198°) in the CG and 0.100 ± 0.029° (95% CI 0.009–0.049°) in the TG (p = 0.000). In the TG, there were no statistically significant differences in the mean angle deviation within the group (p > 0.05), but there were in the CG. A colorimetric analysis showed higher deviations from the original model for the six-implant impression without a prosthetic template. Conclusions: Although all of the impressions exhibited deviation from the original model in the range of clinical acceptability, the prosthetic-based impression template significantly improved the trueness and precision of complete edentulous arches rehabilitated with four or six implants, making the complete arch digital impression more predictable. [ABSTRACT FROM AUTHOR]

Continuously evolving technologies make dentistry one of the most advanced sectors in the field of medicine. The digital improvements in recent years have brought many advantages to clinicians and patients, including reduced working times, lower costs and increased efficiency of performance. Some of the most important digital technologies introduced in the dental filed are cone beam computer tomography (CBCT) scan, Computer Aided Design/Computer Aided Manufacturing (CAD-CAM) systems, and intraoral scanners. All of these allow faster and more accurate rehabilitations, with the opportunity of pre-simulation of the final treatment. The evolution of computer science has brought significant advantages in the medical and dental fields, making the diagnosis and execution of even complex treatments, such as implantology and bone reconstruction, possible. The digital world is trying to supplant the traditional analog workflow, and over time, with the further advance of technologies, it should tend to be the treatment of choice of our patients. [ABSTRACT FROM AUTHOR]

The achievement of the optimal implant position is a critical consideration in implant surgery, as it can facilitate the ideal prosthesis design and allow adequate oral hygiene maintenance. The switch from bone-driven to prosthetic-driven implant placement, through a comprehensive diagnosis and adequate treatment plan, is a prerequisite for long-term successful implant-based therapy. The aim of the present case report is to describe a step-by-step prosthetic retreatment of a patient with primary treatment failure due to incorrect dental implant placement. Although dental implants achieve high survival rates, the success of implant prosthetic therapy significantly relies on an appropriate implant position. Malpositioned implants can cause damage to vital structures, like nerves or vessels. Moreover, improper implant positioning can result in esthetic, biological, and technical complications and can, in extreme situations, render the desired prosthetic rehabilitation impossible to achieve. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate implant and prosthetic survival rates, complications, patient satisfaction, and biological outcomes of patients rehabilitated with a ball attachment system for implant retained- and supported-overdentures (IOV), which was in function for 3 to 5 years. Methods: This retrospective study evaluated data collected from patients treated between April 2001 and May 2018 with IOV on splinted and non-splinted implants and a ball attachment system. Patients were followed for 36 to 206 months (mean follow-up was 128.1 ± 51.9 months). Data were collected at the 3- and 5-year follow-up examination. Outcome measures were implant and prosthetic survival rates, technical complications, marginal bone loss (MBL), oral health impact profile (OHIP), and periodontal parameters (bleeding on probing and plaque index). Results: A total of 46 patients (16 males and 30 females) with 124 implants were included in this study. Twenty-five implant-retained overdentures were delivered on 53 unsplinted implants, while the other 21 patients received an implant-supported overdentures and the implants were splinted. At the five-year follow-up examination, one implant and one prosthesis failed in the unsplinted group, resulting in a cumulative survival rate of 97.8% at the patient level. Two minor technical complications were experienced. Conclusions: Implant overdenture retained or supported by ball attachment systems showed high implant and prosthetic survival and success rates. A low number of complications, high patient satisfaction, and successful biological parameters were experienced in the mid-term follow-up. Data need to be confirmed by further randomized trials. [ABSTRACT FROM AUTHOR]

Purpose: To compare virtual planning accuracy of novel computer-assisted, template-based implant placement techniques, which make use of CAD/CAM stereolithographic surgical templates with or without metallic sleeves. Furthermore, to compare open versus closed sleeves for templates without metallic sleeves. Materials and methods: Any partially edentulous patients requiring at least one implant to be placed according to a computer-assisted template-based protocol were enrolled. Patients were randomized according to a parallel group design into two arms: Surgical template with or without metallic sleeves. Three deviation parameters (angular, horizontal, vertical) were defined to evaluate the discrepancy between the planned and placed implant positions. Results: No implants failed, and no complications were experienced. Forty-one implants were placed using surgical templates with metallic sleeves while 49 implants were placed with a surgical template without metallic sleeves. Of these, 16 implants were placed through open sleeves and 33 through closed sleeves. There was a statistically significant difference in angle (p = 0.0212) and in the vertical plan (p = 0.0073) with lower values for implants placed with a surgical template without metallic sleeves. In the test group, close sleeves were more accurate compared with open sleeves in angle (p = 0.0268) and in horizontal plan (p = 0.0477). Conclusion: With the limitations of the present study, surgical templates without metallic sleeves were more accurate in the vertical plan and angle compared to the conventional template with metallic sleeves. Open sleeves should be used with caution in the molar region only in case of reduced interarch space. Further research is needed to confirm these preliminary results. [ABSTRACT FROM AUTHOR]

Background: The aim of the present prospective case series study was to evaluate the implant and prosthetic survival rates, complications and marginal bone loss using ultra-fine titanium mesh membrane with simultaneous implant placement, to provide space maintenance mandatory for guided bone reconstruction of alveolar bone defects. Materials and Methods: patients were recruited and treated at a private clinic in Rome, Italy, between March 2016 and October 2017. Self-tapping tapered implants were placed through a computer-guided template-assisted approach. Autogenous bone was placed alone over the exposed implant surface, then mixed with inorganic bovine bone material. Finally, the membrane was connected and shaped in order to securely enclose the graft area, and the healing cap was connected and screwed onto the height connector. Outcome measures were: implant and prosthetic failure, biological and mechanical complications, marginal and volumetric bone level changes, esthetic evaluation performed according to the pink aesthetic score (PES). Results: in total, seven patients (five women, two men) with a mean age of 52.7 ± 20.3 years (range: 27–71) received 10 self-tapping tapered implants and simultaneous guided bone regeneration with ultra-fine titanium mesh membranes. No implants and no prostheses failed during the entire follow-up period. One slightly membrane exposure was observed one month after implant placement in one patient. The mean marginal bone loss (MBL) at implant loading was 0.13 ± 0.09 mm (95% CI 0.08–0.19). At the 18-month follow-up examination, the mean MBL was 0.28 ± 0.33 mm (95% CI 0.07–0.50) The difference was not statistically significant (0.15 ± 0.31; 95% CI 0.05–0.35; P = 0.1888). The mean horizontal alveolar ridge width was 3.72 ± 1.08 mm (95% CI 3.22–4.22 mm). At the II-stage surgery, the mean bone width was 8.79 ± 0.98 mm (95% CI 8.51–9.07 mm). The mean bone gain was 5.06 ± 1.13 mm (95% CI 4.68–5.44 mm; P = 0.000). The mean volume of the grafted bone calculated using the superimposition technique was 0.99 ± 0.38 CC (95% CI 0.75–1.23 CC). The mean PES at implant loading was 8.2 ± 0.8 mm (95% CI 7.7–8.7). At the 18-month follow-up examination, the mean PES was 12.0 ± 0.7 mm (95% CI 11.5–12.5) The difference was statistically significant (3.8 ± 0.4; 95% CI 3.5–4.1; P = 0.0000); Conclusion: with the limitation of the present prospective study, the guided bone reconstruction using an ultra-fine titanium mesh membrane with simultaneous implant placement seems to provide good and stable results in implant/prosthesis success. Further research with a longer follow-up and a higher sample size are needed to confirm the results from this preliminary report. [ABSTRACT FROM AUTHOR]

Biochemical modification of titanium surfaces (BMTiS) entails immobilization of biomolecules to implant surfaces in order to induce specific host responses. This crossover randomized clinical trial assesses clinical success and marginal bone resorption of dental implants bearing a surface molecular layer of covalently-linked hyaluronan in comparison with control implants up to 36 months after loading. Patients requiring bilateral implant rehabilitation received hyaluronan covered implants in one side of the mouth and traditional implants in the other side. Two months after the first surgery, a second surgery was undergone to uncover the screw and to place a healing abutment. After two weeks, the operator proceeded with prosthetic procedures. Implants were evaluated by periapical radiographs and the crestal bone level was recorded at mesial and distal sites—at baseline and up to 36 months. One hundred and six implants were positioned, 52 HY-coated, and 48 controls were followed up. No differences were observed in terms of insertion and stability, wound healing, implant success, and crestal bone resorption at any time considered. All interventions had an optimal healing, and no adverse events were recorded. This trial shows, for the first time, a successful use in humans of biochemical-modified implants in routine clinical practice and in healthy patients and tissues with satisfactory outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To analyze implant and prosthetic survival rates, complications, patient satisfaction, and biological parameters of patients rehabilitated with implant overdentures (IOV) on splinted and nonsplinted implants and different attachment systems, in function for one to 17 years. Methods: This retrospective study evaluated data collected from patients rehabilitated with implant overdentures between January 2001 and December 2016 in nine different centers. Outcome measures were implant and prosthetic success rates, mechanical complications, marginal bone loss (MBL), oral health impact profile (OHIP), bleeding on probing, and plaque index. Results: A total of 581 implants were installed in 194 patients. Patients were followed for a mean period of 60.6 months (range 6–206). Eighty-nine patients received 296 low profile attachment (OT Equator), 62 patients received 124 ball attachments, and 43 patients received 107 Locator attachments. In eighty-three patients the implants were splinted with computer aided design/computer aided manufacturing (CAD/CAM) or casted bar. At the last follow-up, 10 implants failed in eight patients. Statistical significance was found for failed prostheses (P = 0.0723) and complications (P = 0.0165), with better values for splinted implants. No statistically significant differences were found in proportion of implant and prosthetic failure (P > 0.05). At a five-year follow-up, proportion of complications (P = 0.0289) and failed prostheses (P = 0.0069) were statistically higher for IOV on Locator attachments. No difference was founded in MBL at one- and two-year follow-up between different attachment systems (P > 0.05). Statistically significant improvement in all the OHIP categories was reported in all the patients, after one year of function. Conclusions: Implant overdenture showed high implant and prosthetic survival rates, low complications, high patient satisfaction, and good biological parameters in the long-term follow-up. Splinting the implants may reduce number of mechanical complications. Locator attachments showed higher number of complications. Further studies are needed to confirm these preliminary results. [ABSTRACT FROM AUTHOR]

The purpose of the present study was to evaluate the histological and histomorphometric characteristics of post-extraction sites grafted with decellularized bovine compact bone from bovine femur, mixed and unmixed with leukocyte- and platelet-rich fibrin after four months of healing. This study was designed as a randomized controlled trial of parallel groups. Patients in need of a single, implant-supported restoration to replace a hopeless tooth were recruited for tooth extraction and implant placement four months after socket preservation procedure. After tooth extraction, patients were randomly allocated to receive decellularized bovine compact bone from bovine femur, mixed and unmixed with leukocyte- and platelet-rich fibrin. After four months of healing, tapered implants were inserted with an insertion torque between 35 and 45 Ncm. Two months later, implants were loaded with screw-retained definitive crowns. Outcome measures were implant (ISR) and prosthesis (PSR) survival rates, complications, histological and histomorphometric analyses, radiographic marginal bone-level changes, and patients' satisfaction. Clinical data were collected up to one year after tooth extraction and socket preservation procedures. Thirty patients were consecutively enrolled in the trial (15 in each group). Unfortunately, due to the COVID-19 pandemic, bone samples were collected only in 19 patients. Two implants failed before definitive prosthesis delivery (ISR 93.3%). No prosthesis failed (PSR 100%). Three complications were experienced in the control group. The mean bone percentage was 40.64 ± 18.76 in the test group and 33.40 ± 22.38 in the control group. The difference was not statistically significant ( p = 0.4846). The mean soft tissue percentage was 32.55 ± 19.45 in the test group and 55.23 ± 17.64 in the control group. The difference was statistically significant ( p = 0.0235). The mean residual graft was 24.59 ± 18.39 in the test group and 11.37 ± 12.12 in the control group. The difference was not statistically significant ( p = 0.0992). Mean marginal bone loss, as well as patient satisfaction, showed no differences between groups. With the limitations of the present study, socket preservation with L-PRF mixed with decellularized bovine compact bone demonstrated favorable results, comparing with decellularized bovine compact bone from bovine femur alone. Further studies with larger sample size and longer follow-up are needed to confirm these preliminary results.